title: Leprosy type 1 reaction as the first manifestation of borderline lepromatous leprosy in a young native German.
abstract: While leprosy is usually a chronic disease, leprosy reactions may lead to acute problems. These reactions most often occur after initiation of therapy, but can also develop before treatment. Leprosy rarely presents with a reaction. We describe a German patient who presented in this unusual way in order to demonstrate the various tools used to confirm the diagnosis. A young German woman suddenly developed progressive functional loss of the left hand and within a few weeks an increasing number of erythematous macules and nodules appeared. Histological examination of a skin biopsy revealed tuberculoid granulomas, some located around small nerves; acid-fast bacilli were detected microscopically and DNA from Mycobacterium leprae was identified by polymerase chain reaction in the biopsy and a nasal swab; serological tests were positive. The disease was classified as borderline lepromatous leprosy. The acute neuritis followed by skin lesions represented a leprosy type 1 reaction in which the immune system reacts to bacilli previously unrecognized in nerve tissue, both in nerve and skin.
authors.affiliation: Department of Dermatology, Ludwig-Maximilians University, Munich, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Biedermann
authors.forename: K
authors.initials: K
authors.lastname: Degitz
authors.forename: C G
authors.initials: CG
authors.lastname: Schirren
authors.forename: W
authors.initials: W
authors.lastname: Burgdorf
authors.forename: G
authors.initials: G
authors.lastname: Plewig
authors.forename: T
authors.initials: T
authors.lastname: Bieber
mesh_terms: D000208:Acute Disease; D000328:Adult; D005260:Female; D006225:Hand / Q000294:innervation; D006801:Humans; D007918:Leprosy / Q000145:classification; D015440:Leprosy, Lepromatous / Q000150:complications / Q000473:pathology*; D009443:Neuritis / Q000209:etiology